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Donepudi VR, Giovanni EG, Yusa T, Akatsuka T, Takeda T, Cesareo R, Brunetti A, Schiavon N. Relativistic impulse approximation-based compton component of mass energy absorption coefficients (cm 2/g) for few materials of medical interest. Appl Radiat Isot 2024; 206:111193. [PMID: 38412773 DOI: 10.1016/j.apradiso.2024.111193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/23/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
Total, whole-atom, individual and integrated Compton scattering cross sections and Compton energy absorption scattering cross sections are evaluated for light elements, such as, H, C, N, O, P, and Ca, with relativistic impulse approximation methods. Most of the phantom materials composed of these elements, which are the basic constituents of biological soft-tissue and attenuation through them, provides potential source of information. Compton scattering cross-sections for few biological materials, such as, H2O, C2H4, C8H8, C5H8O2, C6H11NO, C16H14O3, C55H102O6, [Ca3(PO4)]3Ca (OH)2 of medical interest, have been evaluated with the use of double differential scattering cross-section based on impulse approximation. Utilized these values to evaluate the Compton energy absorption cross sections and Compton component of mass energy absorption coefficients (cm2/g) in the energy region from 0.005 to 10 MeV. The derived results are compared with the theoretical tabulations.
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Affiliation(s)
- V Rao Donepudi
- Department of Science Based Applications to Engineering (SBAI), Physics Division, University of Rome "La Sapienza" Via Scarpa 10, 00161, Roma, Italy.
| | - E Gigante Giovanni
- Department of Science Based Applications to Engineering (SBAI), Physics Division, University of Rome "La Sapienza" Via Scarpa 10, 00161, Roma, Italy
| | - Tetsuya Yusa
- Department of Bio-System Engineering, Faculty of Engineering, Yamagata University, Yonezawa, Japan
| | - Tako Akatsuka
- Department of Bio-System Engineering, Faculty of Engineering, Yamagata University, Yonezawa, Japan
| | - Tohoru Takeda
- Health Science Division, Kitasato University, Kitasato, Japan
| | - Roberto Cesareo
- Instituto di Fisica e Mathematica, Universita di Sassari, Via Vienna, Sassari, 2-07100, Italy
| | - Antonio Brunetti
- Instituto di Fisica e Mathematica, Universita di Sassari, Via Vienna, Sassari, 2-07100, Italy
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2
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Porcaro M, Cesareo R, Bustamante A, Brunetti A. Characterization of an Ancient Bimetallic Alloy from Moche Civilization (Peru). Materials (Basel) 2023; 16:7211. [PMID: 38005140 PMCID: PMC10673082 DOI: 10.3390/ma16227211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
The Moche civilization in Peru developed marvelous metallurgy, primarily using alloys of gold, copper and silver, with the most famous of them called Tumbaga, which resembles pure gold after a depletion process on its surface. However, they also created objects with more standard single-layer alloys or gilding. To distinguish between these techniques in a non-destructive manner is essential. Here, we analyzed a thigh protector, composed of two parts, one seemingly in silver and the other seemingly in gold. The sample was analyzed using X-ray fluorescence measurements integrated with Monte Carlo simulation. The results show that the silver part is formed of a silver-based alloy covered in a corrosion layer, while the gold part is made of Tumbaga. Moreover, for the first time, the gold profiles of different Tumbaga gold objects, from the same burial, were compared, allowing us to obtain information about the standardization of their manufacture.
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Affiliation(s)
- Marta Porcaro
- Department of the Earth Sciences, University “La Sapienza” of Rome, 00185 Roma, Italy
| | | | - Angel Bustamante
- Solid State Physics Department, National University of San Marcos, Lima 15081, Peru;
| | - Antonio Brunetti
- Biomedical Sciences Department, University of Sassari, 07100 Sassari, Italy
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3
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Gaspa G, Naciu AM, DI Rosa C, Lattanzi G, Beato I, Micheli V, Turriziani C, Khazrai YM, Cesareo R. Short- and long-term effects of very low- and low-calorie ketogenic diets on metabolism and cardiometabolic risk factors: a narrative review. Minerva Endocrinol (Torino) 2023; 48:318-333. [PMID: 36285748 DOI: 10.23736/s2724-6507.22.03922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Worldwide obesity and cardiovascular diseases have encouraged the adoption of new and efficient dietary strategies. Among various proposed diets, ketogenic diets, both the very-low-calorie ketogenic diet (VLCKD) and the low-calorie ketogenic diet (LCKD), have been suggested in recent years as an effective nutritional approach for obesity management. The VLCKD and the LCKD are characterized by a low carbohydrate content (<50 g/day), 1-1.5 g of protein/kg of ideal body weight, less than 20-30 g of lipids, and a daily intake of about 800 calories for VLCKD and about 1200-1400 calories for LCKD. The purpose of our narrative review is to offer an overview of the most impactful studies in the scientific literature regarding VLCKD and LCKD to discuss their short- and long-term effects (less than 12 months and more than 12 months respectively) on weight loss, metabolic and cardiovascular aspects. Articles we focused on were cohort studies, case-control studies, cross-sectional studies, randomized controlled trials, and meta-analyses. Results indicate that VLCKD and LCKD could be helpful to ameliorate metabolic and cardiovascular risk factors such as weight loss, glucose, and cholesterol levels, both in the short and long term. Further research in this area may include more randomized controlled trials to gather more data.
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Affiliation(s)
- Gianluigi Gaspa
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy -
| | - Anda M Naciu
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Claudia DI Rosa
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Greta Lattanzi
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Ivan Beato
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Vanessa Micheli
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Clara Turriziani
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Yeganeh M Khazrai
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, 'S.M. Goretti' Hospital, Latina, Italy
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Tombini M, Palermo A, Ricci L, Boscarino M, Flavia N, Biagio S, Naciu AM, Tabacco G, Cesareo R, Di Lazzaro V, Assenza G. Evaluating the effect of calcifediol supplementation on seizure frequency in people with drug-resistant epilepsy. Epilepsy Behav 2023; 145:109334. [PMID: 37385120 DOI: 10.1016/j.yebeh.2023.109334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
The well-known neuroprotective role and involvement of vitamin D in the function of the central nervous system has raised the speculation about the possible antiseizure effect of vitamin D supplementation. This issue is crucial when considering people with epilepsy (PWE), who frequently display vitamin D deficiency, but nowadays data are still unconclusive. In our study, we enrolled 25 adult patients affected by drug-resistant epilepsy and hypovitaminosis D to test the effect of Calcifediol on seizure frequency after 6 months of supplementation. Our findings evidenced that Calcifediol administration completely restored 25-hydroxy vitamin D (25-OHD) and intact parathyroid hormone (iPTH) serum values (p < 0.001 for both) without significant changes of median seizure frequency (-6.1%). Anyway, we observed some rate of PWE responders (32%) to Calcifediol supplementation. Further randomized controlled trials with larger subjects 'samples will be needed to verify the possible antiseizure effect of vitamin D.
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Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Narducci Flavia
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Sancetta Biagio
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
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Tabacco G, Naciu AM, Messina C, Sanson G, Rinaudo L, Cesareo R, Falcone S, Napoli N, Ulivieri FM, Palermo A. DXA-based bone strain index in normocalcemic primary hyperparathyroidism. Osteoporos Int 2023; 34:999-1003. [PMID: 36640186 DOI: 10.1007/s00198-023-06669-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
UNLABELLED The trabecular and cortical bone assessed by bone strain index seems not to be significantly affected in NHPT. INTRODUCTION The natural history and bone involvement of normocalcemic hyperparathyroidism (NHPT) are not fully clarified yet. The bone strain index (BSI) is a deformation index based on the finite element method and can be applied to DXA scans. In this study, we aim to assess BSI in subjects with NHPT. METHOD A case-control study included 170 subjects: 40 subjects with NHPT, 50 subjects with primary hypercalcemic hyperparathyroidism (PHPT), and 80 controls (age- and sex-matched with the NPTH group). RESULTS Lumbar spine (LS) bone mineral density (BMD), femoral neck (FN) BMD, total hip (TH) BMD, and TBS were similar between NHPT and both PHPT and controls. FN-BSI was lower in NHPT compared to PHPT (1.52 ± 0.31 vs 1.72 ± 0.42 p = 0.031) while there were no differences between NHPT and controls. TH-BSI was lower in NHPT compared to PHPT (1.36 ± 0.23 vs 1.52 ± 0.34, p = 0.030), while there were no differences between NHPT and controls. LS-BSI was not different between NHPT and both PHPT and controls. CONCLUSION The trabecular and cortical bones assessed by BSI seem not to be significantly impaired in NHPT. Further prospective studies are needed to confirm these findings and to give an insight into the natural history of NHPT to improve knowledge and management of this condition.
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Affiliation(s)
- Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Anda Mihaela Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Sanson
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Stefania Falcone
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | - Nicola Napoli
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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Palermo A, Cesareo R. Response to Letter to the Editor From Xu and Yang: "Laser Ablation Versus Radiofrequency Ablation for Thyroid Nodules: 12-Month Results of a Randomized Trial (LARA II Study)". J Clin Endocrinol Metab 2022; 107:e4328-e4329. [PMID: 36056638 DOI: 10.1210/clinem/dgac505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Palermo
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- Center of Metabolic Disease, S.M. Goretti Hospital, Latina, Italy
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Cesareo R, Egiddi S, Naciu AM, Tabacco G, Leoncini A, Napoli N, Palermo A, Trimboli P. Efficacy of radiofrequency and laser thermal ablation in solving thyroid nodule-related symptoms and cosmetic concerns. A systematic review and meta-analysis. Rev Endocr Metab Disord 2022; 23:1051-1061. [PMID: 35768704 PMCID: PMC9515040 DOI: 10.1007/s11154-022-09743-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
Abstract
Several studies have showed good/excellent results of thermal-ablation (TA) to reduce volume of benign thyroid nodule (TN). Nevertheless, no systematic review has reported information about clinical achievements with TA. Being the latter of high interest, this systematic review was undertaken to achieve high evidence about the efficacy of TA in reducing TN-related symptoms and cosmetic concerns. Radiofrequency (RFA) and laser (LA) therapies were considered. A comprehensive literature search of online databases was performed on January 2022 looking for studies reporting clinical results obtained by RFA or LA in terms of VAS (namely, Visual Analogic Scale) and cosmetic concerns. Initially, 318 records were found and 14 were finally included in the meta-analysis. VAS data were available in all RFA studies and the pooled mean reduction was of 3.09 points with significant heterogeneity. Cosmetic score data were available in 11 RFA studies and the pooled mean reduction was of 1.45 with significant heterogeneity. Regarding LA studies, 4 series reported VAS data and the pooled mean reduction was of 2.61 points with significant heterogeneity. The analysis of LA data about cosmetic concerns was not performed due to data paucity. Importantly, heterogeneities were not explained by meta-regression analyses using several covariates (i.e., baseline TN volume, follow-up duration, volume reduction rate). This systematic review showed that clinical data about TN TA efficacy are sparse and affected by high unexplained inconsistency. International societies should give indication about how we should clinically select and evaluate patients undergoing TN TA.
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Affiliation(s)
- Roberto Cesareo
- Center of Metabolic Disease, S.M. Goretti Hospital, Latina, Italy
| | - Silvia Egiddi
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anda M Naciu
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Leoncini
- Servizio Di Radiologia E Radiologia Interventistica, Istituto Di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Nicola Napoli
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierpaolo Trimboli
- Servizio Di Endocrinologia E Diabetologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
- Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland.
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Naciu AM, Tabacco G, Bilezikian JP, Santonati A, Bosco D, Incognito GG, Gaspa G, Manfrini S, Falchetti A, Trimboli P, Mazziotti G, Napoli N, Sanson G, Cesareo R, Vescini F, Palermo A. Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial. J Bone Miner Res 2022; 37:1251-1259. [PMID: 35466449 PMCID: PMC9542059 DOI: 10.1002/jbmr.4564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
In hypoparathyroidism (HypoPT), calcium supplementation is virtually always required, although the disease is likely to be associated with an increased risk of nephrolithiasis. The use of calcium citrate (Ca-Cit) theoretically could have a positive impact on the nephrolithiasis risk because citrate salts are used to reduce this risk. Our objective was to evaluate the potential therapeutic advantage of Ca-Cit in comparison with calcium carbonate (CaCO3 ) in HypoPT, on nephrolithiasis risk factors, as well as to their ability to maintain desirable serum calcium levels. We also evaluated these preparations on quality of life (QOL). This randomized, double-blind, crossover trial recruited 24 adults with postsurgical chronic hypoparathyroidism at Campus Bio-Medico University of Rome. Participants were randomized 1:1 to Ca-Cit or CaCO3 for 1 month and then crossed over to the other treatment for another month. The primary outcomes were changes in albumin-adjusted serum calcium and in ion activity product of calcium oxalate levels (AP[CaOx] index). Secondary efficacy outcomes included changes in SF-36 survey score, fatigue score, constipation, and adverse events. No difference in terms of AP(CaOx) index was observed between the two groups. However, Ca-Cit was associated with a significant reduction in the oxalate/creatinine ratio compared with CaCO3 (-2.46 mmol/mol [SD 11.93] versus 7.42 mmol/mol [SD 17.63], p = 0.029). Serum calcium and phosphorus concentration was not different between the two calcium preparations. Ca-Cit was associated with less constipation (p = 0.047). No difference was found in QOL scores. Although Ca-Cit did not modify the AP(CaOx) index when compared with CaCO3, it was associated with a reduction in urinary oxalate excretion that could have a potential beneficial effect on nephrolithiasis risk. These results are likely to have clinical implications in HypoPT, particularly those who do not tolerate CaCO3 and those affected by nephrolithiasis. A longer-term experience is needed to confirm these findings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Anda Mihaela Naciu
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.,Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome
| | - Gaia Tabacco
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.,Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Daniela Bosco
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | | | - Gianluigi Gaspa
- Department of Food Science and Nutrition, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome
| | - Alberto Falchetti
- Department of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Nicola Napoli
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.,Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. M. Misericordia of Udine, Udine, Italy
| | - Andrea Palermo
- Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.,Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Mauri G, Bernardi S, Palermo A, Cesareo R. Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group. Endocrine 2022; 76:1-8. [PMID: 35290617 PMCID: PMC8986658 DOI: 10.1007/s12020-022-03005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE In this paper, the members of the Italian Working Group on Minimally-Invasive Treatments of the Thyroid (MITT group) aim to summarize the most relevant information that could be of help to referring physicians and that should be provided to patients when considering the use of MITT for the treatment of benign thyroid nodules. METHODS An interdisciplinary board of physicians with specific expertise in the management of thyroid nodules was appointed by the Italian MITT Group. A systematic literature search was performed, and an evidence-based approach was used, including also the knowledge and the practical experience of the panelists to develop the paper. RESULTS The paper provides a list of questions that are frequently asked by patients to operators performing MITT, each with a brief and detailed answer and more relevant literature references to be consulted. CONCLUSIONS This paper summarizes the most relevant information to be provided to patients and general practitioners/referring physicians about the use of MITT for the treatment of benign thyroid nodules.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy.
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.
| | - Stella Bernardi
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
- UCO Medicina Clinica, Azienda Sanitaria Universitaria Integrata Trieste (ASUGI), Trieste, Italy
| | - Andrea Palermo
- Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Ospedale Santa Maria Goretti, Latina, Italy
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Cesareo R, Tabacco G, Naciu AM, Crescenzi A, Bernardi S, Romanelli F, Deandrea M, Trimboli P, Palermo A, Castellana M. Long-term efficacy and safety of percutaneous ethanol injection (PEI) in cystic thyroid nodules: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2022; 96:97-106. [PMID: 34028855 DOI: 10.1111/cen.14530] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Percutaneous ethanol injection (PEI) is used for the treatment of benign cystic thyroid nodules. This systematic review and meta-analysis aimed to obtain strong evidence of its long-term efficacy and safety. METHODS PubMed, CENTRAL, Scopus and Web of Science databases were searched until November 2020 for studies reporting data on volume reduction rate (VRR), compressive symptoms and cosmetic concerns. Associated complications were assessed. A random-effects model was designed to pool the data. RESULTS Out of 385 papers, nine studies evaluating 1667 nodules were finally included. Overall, VRR at 6, 12, 24, 36, 60 and 120 months was 77%, 81%, 72%, 68%, 74% and 69%, respectively. Significant reductions in the compressive symptoms and cosmetic concerns were observed. No permanent complications were observed. CONCLUSIONS The present meta-analysis showed that PEI could significantly reduce the volume of benign cystic thyroid nodules. This reduction was already effective at 6 months post-treatment, and the effect was stable over time.
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Affiliation(s)
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Anna Crescenzi
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Stella Bernardi
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
- UO Medicina Clinica, Ospedale di Cattinara, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy
| | - Francesco Romanelli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
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Vescini F, Chiodini I, Falchetti A, Palermo A, Salcuni AS, Bonadonna S, De Geronimo V, Cesareo R, Giovanelli L, Brigo M, Bertoldo F, Scillitani A, Gennari L. Management of Osteoporosis in Men: A Narrative Review. Int J Mol Sci 2021; 22:ijms222413640. [PMID: 34948434 PMCID: PMC8705761 DOI: 10.3390/ijms222413640] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women.
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Affiliation(s)
- Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.V.); (A.S.S.)
| | - Iacopo Chiodini
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
- Correspondence:
| | - Alberto Falchetti
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Antonio Stefano Salcuni
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.V.); (A.S.S.)
| | - Stefania Bonadonna
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
| | | | - Roberto Cesareo
- Center of Metabolic Disease, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
| | - Martina Brigo
- Department of Medicine, University of Verona, 37129 Verona, Italy; (M.B.); (F.B.)
| | - Francesco Bertoldo
- Department of Medicine, University of Verona, 37129 Verona, Italy; (M.B.); (F.B.)
| | - Alfredo Scillitani
- Unit of Endocrinology, Ospedale “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
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Mauri G, Papini E, Bernardi S, Barbaro D, Cesareo R, De Feo P, Deandrea M, Fugazzola L, Gambelunghe G, Greco G, Messina C, Monti S, Mormile A, Negro R, Offi C, Palermo A, Persani L, Presciuttini F, Solbiati LA, Spiezia S, Stacul F, Viganò M, Sconfienza LM. Image-guided thermal ablation in autonomously functioning thyroid nodules. A retrospective multicenter three-year follow-up study from the Italian Minimally Invasive Treatment of the Thyroid (MITT) Group. Eur Radiol 2021; 32:1738-1746. [PMID: 34751793 DOI: 10.1007/s00330-021-08289-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy.
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy.
| | - Enrico Papini
- Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Stella Bernardi
- UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | | | | | | | - Salvatore Monti
- UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | | | - Chiara Offi
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Andrea Palermo
- Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy
| | | | - Luigi Alessandro Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Spiezia
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Fulvio Stacul
- SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy
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14
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Tabacco G, Naciu AM, Messina C, Sanson G, Rinaudo L, Cesareo R, Falcone S, Manfrini S, Napoli N, Bilezikian JP, Ulivieri FM, Palermo A. DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism. J Clin Endocrinol Metab 2021; 106:2304-2312. [PMID: 33963754 PMCID: PMC8599893 DOI: 10.1210/clinem/dgab317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual-energy x-ray absorptiometry (DXA) images. OBJECTIVE To assess the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT patients compared with controls and to investigate the association of BSI with vertebral fractures (VFs) in PHPT. METHODS This case-control study enrolled 50 PHPT patients and 100 age- and sex-matched control subjects from an outpatient clinic. The main outcome measures were LS-BSI, FN-BSI, and TH-BSI. RESULTS FN bone mineral density (BMD) and one-third distal radius BMD were lower in the PHPT group than in controls (FN 0.633 ± 0.112 vs 0.666 ± 0.081, P = 0.042; radius 0.566 ± 0.07 vs 0.625 ± 0.06, P < 0.001). PHPT group has significant lower TBS score compared with controls (1.24 ± 0.09 vs 1.30 ± 0.10, P < 0.001). BSI was significantly higher at LS (2.28 ± 0.59 vs 2.02 ± 0.43, P = 0.009), FN (1.72 ± 0.41 vs 1.49 ± 0.35, P = 0.001), and TH (1.51 ± 0.33 vs 1.36 ± 0.25, P = 0.002) in PHPT. LS-BSI showed moderate accuracy for discriminating VFs (AUC 0.667; 95% CI, 0.513-0.820). LS-BSI ≥ 2.2 and was a statistically significant independent predictor of VFs, with an adjusted odds ratio ranging from 5.7 to 15.1. CONCLUSION BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures.
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Affiliation(s)
- Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Gianfranco Sanson
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Stefania Falcone
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA
| | - Fabio M Ulivieri
- U.O. Medicina Nucleare, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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Bernardi S, Palermo A, Grasso RF, Fabris B, Stacul F, Cesareo R. Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review. Cancers (Basel) 2021; 13:2746. [PMID: 34205994 PMCID: PMC8199252 DOI: 10.3390/cancers13112746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. METHODS We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. RESULTS A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. CONCLUSIONS US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Andrea Palermo
- Unità di Endocrinologia e Diabete, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Rosario Francesco Grasso
- U.O.S. Radiologia Interventistica, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Fulvio Stacul
- S.C. Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Maggiore Hospital, 34125 Trieste, Italy;
| | - Roberto Cesareo
- U.O.S. Malattie Metaboliche, Ospedale Santa Maria Goretti, 04100 Latina, Italy;
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Cesareo R, Manfrini S, Pasqualini V, Ambrogi C, Sanson G, Gallo A, Pozzilli P, Pedone C, Crescenzi A, Palermo A. Laser Ablation Versus Radiofrequency Ablation for Thyroid Nodules: 12-Month Results of a Randomized Trial (LARA II Study). J Clin Endocrinol Metab 2021; 106:1692-1701. [PMID: 33608728 DOI: 10.1210/clinem/dgab102] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Radiofrequency ablation (RFA) seems to achieve a significantly larger nodule volume reduction rate (VRR) than laser ablation (LA) in benign nonfunctioning thyroid nodules (BNTNs). OBJECTIVE To compare the efficacy and safety of both treatments at 12-month follow-up in patients with solid or predominantly solid BNTN. METHODS This was a single-center, 12-month, randomized, superiority, open-label, parallel-group trial conducted in an outpatient clinic. Sixty patients with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems were randomly assigned (1:1 ratio) to receive either a single session of RFA or LA. Twenty-9 patients per group completed the study. The main outcome measures were VRR and proportion of nodules with more than 50% reduction (technical success rate). RESULTS At 12 months, VRR was 70.9 ± 16.9% and 60.0 ± 19.0% in the RFA and LA groups, respectively (P = .024). This effect was confirmed in the linear regression model that was adjusted for age, sex, nodule baseline volume, and proportion of cellular components (RFA treatment: β = .390; P = .009). No significant between-group difference was observed in the technical success rate at 12 months after treatment. A statistically significant improvement was observed from the baseline to the 12-month follow-up for compression (RFA: 4.6 ± 2.6 and 1.3 ± 0.8, P < .001; and LA: 4.6 ± 2.1 and 1.6 ± 0.8, respectively, P < .001) and cosmetic (RFA: 3.4 ± 0.6 and 1.3 ± 0.5, P < .001; and LA: 3.4 ± 0.5 and 1.4 ± 0.6, P < .001) scores although the between-group differences were not significant. CONCLUSION RFA achieved a significantly larger nodule volume reduction at 12 months; however, the technical success rate was similar in the RFA and LA groups.
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Affiliation(s)
- Roberto Cesareo
- Unit of metabolic diseases, "S. M. Goretti" Hospital, Latina, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | | | - Cesare Ambrogi
- Department of Radiology, "S. M. Goretti" Hospital, Latina, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Gallo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Claudio Pedone
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Anna Crescenzi
- Unit of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
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17
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Naciu AM, Tabacco G, Falcone S, Incognito GG, Chiodini I, Maggi D, Pedone C, Lelli D, Bilezikian JP, Napoli N, Manfrini S, Cesareo R, Palermo A. Bone Quality as Measured by Trabecular Bone Score in Normocalcemic Primary Hyperparathyroidism. Endocr Pract 2021; 27:992-997. [PMID: 33962077 DOI: 10.1016/j.eprac.2021.04.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The impact of normocalcemic hyperparathyroidism (NHPT) on bone quality remains largely unexplored. We aimed to investigate the usefulness of trabecular bone score (TBS) assessment in NHPT and the accuracy of TBS in predicting vertebral fractures (VFs) in NHPT. METHODS In this multicentric cross-sectional study, we assessed the TBS in 47 subjects with NHPT, 41 with primary hyperparathyroidism (PHPT), and 39 age- and sex-matched control subjects. RESULTS TBS values did not differ among the 3 groups. The prevalence of low TBS (TBS < 1.2) was 23.4% in NHPT, 26.8% in PHPT, and 15.4% in controls, without statistically significant differences between groups. However, we found a lower lumbar spine Z-score adjusted for TBS (LS Z-score∗TBS) in PHPT participants when compared with controls (-0.48 ± 1.06 vs 0.07 ± 0.93, P = .017). In NHPT group, LS Z-score∗TBS did not detect patients with overall VFs (threshold, -0.15; area under the curve, 0.45; 95% CI, 0.253-0.648; accuracy, 55.3%). Instead, it was useful for moderate-severe VFs (threshold, 0.55; area under the curve, 0.81; 95% CI, 0.62-0.996; accuracy, 83%). In PHPT subjects also, TBS did not predict VFs. CONCLUSION In NHPT, TBS is not reduced. When adjusted for TBS, the LS Z-score might predict moderate-to-severe VFs.
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Affiliation(s)
- Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Stefania Falcone
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | | | - Iacopo Chiodini
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, Instituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan Italy
| | - Daria Maggi
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatric, University Campus Bio-Medico, Rome, Italy
| | - Diana Lelli
- Unit of Geriatric, University Campus Bio-Medico, Rome, Italy
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- Unit of malattie metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
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18
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Vescini F, Chiodini I, Palermo A, Cesareo R, De Geronimo V, Scillitani A, Gennari L, Falchetti A. Selenium: A Trace Element for a Healthy Skeleton - A Narrative Review. Endocr Metab Immune Disord Drug Targets 2021; 21:577-585. [PMID: 32600242 DOI: 10.2174/1871530320666200628030913] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
Inadequate serum selenium levels may delay the growth and physiological changes in bone metabolism. In humans, reduced serum selenium concentrations are associated with both increased bone turnover and reduced bone mineral density. Moreover, a reduced nutritional intake of selenium may lead to an increased risk of bone disease. Therefore, selenium is an essential nutrient playing a role in bone health, probably due to specific selenium-proteins. Some selenium-proteins have an antioxidation enzymatic activity and participate in maintaining the redox cellular balance, regulating inflammation and proliferation/differentiation of bone cells too. At least nine selenium-proteins are known to be expressed by fetal osteoblasts and appear to protect bone cells from oxidative stress at bone microenvironment. Mutations of selenium-proteins and reduced circulating levels of selenium are known to be associated with skeletal diseases such as the Kashin-Beck osteoarthropathy and postmenopausal osteoporosis. In addition, the intake of selenium appears to be inversely related to the risk of hip fragility fractures. Recent data suggest that an altered selenium state may affect bone mass even in males and selenium-proteins and selenium concentrations were positively associated with the bone mass at femoral, total and trochanteric sites. However, selenium, but not selenium-proteins, seems to be associated with femoral neck bone mass after adjustment for many bone fracture risk factors. The present review summarizes the findings of observational and interventional studies, which have been designed for investigating the relationship between selenium and bone metabolism.
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Affiliation(s)
- Fabio Vescini
- Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Iacopo Chiodini
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Milan, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, Department of Internal Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Vincenzo De Geronimo
- Department of Internal Medicine-Endocrinology "Policlinico Morgagni", Catania, Italy
| | - Alfredo Scillitani
- Endocrinology Unit, "Casa Sollievo della Sofferenza" IRCCS-Hospital, San Giovanni Rotondo, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Falchetti
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Milan, Italy
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Castellana M, Procino F, Biacchi E, Zupo R, Lampignano L, Castellana F, Sardone R, Palermo A, Cesareo R, Trimboli P, Giannelli G. Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy for Remission of Type 2 Diabetes. J Clin Endocrinol Metab 2021; 106:922-933. [PMID: 33051679 DOI: 10.1210/clinem/dgaa737] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the bariatric procedures most commonly used for the management of obesity. Whether one or the other is associated with a higher chance of remission of type 2 diabetes (T2D) is unclear. OBJECTIVE This work aims to compare the efficacy of RYGB and SG for T2D remission at 1, 3, and 5 years after surgery. DATA SOURCES Four databases were searched until January 2020. STUDY SELECTION Randomized controlled studies with at least 12 months of follow-up of patients with T2D allocated to RYGB or SG were selected. DATA EXTRACTION To ensure uniformity, broad and narrow criteria for T2D remission were defined. The number of patients achieving remission of T2D at each assessment was extracted. Data were pooled using a random-effects model. DATA SYNTHESIS Ten studies were included, evaluating 778 patients. The overall prevalence of achievement of broad and narrow criteria for T2D remission was 73% and 53% at the 1-year, 60% and 48% at the 3-year, and 51% and 43% at the 5-year assessment. Compared to SG, RYGB was associated with a higher chance of achieving broad and narrow criteria for remission at 1 year after surgery (risk ratio [RR] = 1.34 vs RR = 1.22) and broad criteria for remission at 5 years (RR = 1.18). No other differences were found. CONCLUSIONS The present meta-analysis suggests a more favorable effect of RYGB than SG on achieving T2D remission in the short-term only, although the evidence currently available does not clarify whether differences in this outcome are confirmed long term or fade thereafter.
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Affiliation(s)
- Marco Castellana
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Filippo Procino
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Elisa Biacchi
- Ambulatori Multisito per la cura del sovrappeso e dell'obesità, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Roberta Zupo
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Luisa Lampignano
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Fabio Castellana
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Rodolfo Sardone
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Andrea Palermo
- Unità Operativa Malattie Metaboliche, Campus Bio-Medico University, Roma, Italy
| | | | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
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Naciu AM, Verri M, Crescenzi A, Taffon C, Longo F, Frasca L, Tabacco G, Monte L, Palermo A, Crucitti P, Cesareo R. Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200184. [PMID: 33522492 PMCID: PMC7849458 DOI: 10.1530/edm-20-0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 12/04/2022] Open
Abstract
SUMMARY We present the case of a 47-year-old Caucasian previously healthy woman with a voluminous thyroid nodule occupying almost the entire anterior neck region. The lesion had progressively increased in size during the previous 3 months and the patient presented intermittent symptoms of dysphagia and odynophagia with a slight change in voice. Fine needle aspiration showed papillary carcinoma. Based on imaging and cytological findings, the patient underwent total thyroidectomy. The surgical sample revealed a totally enlarged thyroid gland (weight: 208 g) with the presence of a poly-lobulated lesion centrally located and involving the isthmus and both lobes. Hobnail features were present in more than 30% of the neoplastic cells in agreement with the criteria for this subtype. Psammoma bodies and focal necrosis were also present. The extra-thyroidal extension included strap muscles and peri-esophageal glands. Immunohistochemistry using VE1 antibody for detecting BRAF-V600E mutation resulted positive. The final diagnosis was papillary thyroid carcinoma (PTC) hobnail variant (HVPTC)-pT4a. The HVPTC is a rare entity and, in most cases, appears like a unifocal lesion with a maximum tumor size of 8 cm reported so far. To our knowledge, this represents the largest tumor ever described (14 cm), showing rapid growth and with multinodular goiter-like aspect. LEARNING POINTS HVPTC is an aggressive variant of PTC, usually associated with radioactive iodine refractoriness, and a higher mortality rate compared to classic PTC. However, there is a marked individual variability in this association. HVPTC usually appears as small unifocal lesion but a multinodular goiter presentation may occur. The present case highlights that despite of the histology, our patient achieved a high ablation success rate after radioactive iodine therapy.
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Affiliation(s)
- Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Martina Verri
- Unit of Pathology, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Anna Crescenzi
- Unit of Pathology, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Chiara Taffon
- Unit of Pathology, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Filippo Longo
- Unit of Neck and Chest Surgery, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Luca Frasca
- Unit of Neck and Chest Surgery, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Lavinia Monte
- Unit of Endocrinology and Diabetes, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Pierfilippo Crucitti
- Unit of Neck and Chest Surgery, Campus Bio-Medico Univerity of Rome, Rome, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, ‘S.M. Goretti’ Hospital, Latina, Italy
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21
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Briganti SI, Naciu AM, Tabacco G, Cesareo R, Napoli N, Trimboli P, Castellana M, Manfrini S, Palermo A. Proton Pump Inhibitors and Fractures in Adults: A Critical Appraisal and Review of the Literature. Int J Endocrinol 2021; 2021:8902367. [PMID: 33510787 PMCID: PMC7822697 DOI: 10.1155/2021/8902367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Despite the large number of patients worldwide being on proton pump inhibitors (PPIs) for acid-related gastrointestinal disorders, uncertainty remains over their long-term safety. Particularly, the potential side effects of these drugs on bone health have been evaluated in the last years. The purpose of our narrative review is to gather and discuss results of clinical studies focusing on the interactions between PPIs and fracture risk. Data generated mainly from nested case-control studies and meta-analysis suggest that long-term/high-dose PPIs users are characterized by an increased risk of fragility fractures, mainly hip fractures. However, in these studies, the PPIs-induced bone impairment is often not adjusted for different confounding variables that could potentially affect bone health, and exposure to PPIs was reported using medical prescriptions without adherence evaluation. The mechanisms of the PPI-related bone damage are still unclear, but impaired micronutrients absorption, hypergastrinemia, and increased secretion of histamine may play a role. Clinicians should pay attention when prescribing PPIs to subjects with a preexistent high risk of fractures and consider antiosteoporotic drugs to manage this additive effect on the bone. However, further studies are needed to clarify PPIs action on the bone.
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Affiliation(s)
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, Department of Internal Medicine, S. Maria Goretti Hospital, 04100 Latina, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Pierpaolo Trimboli
- Scienza Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Marco Castellana
- Population Health Unit, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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22
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Di Bella S, Cesareo R, De Cristofaro P, Palermo A, Sanson G, Roman‐Pognuz E, Zerbato V, Manfrini S, Giacomazzi D, Dal Bo E, Sambataro G, Macchini E, Quintavalle F, Campagna G, Masala R, Ottaviani L, Del Borgo C, Ridola L, Leonetti F, Berlot G, Luzzati R. Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID-19: A multicentric prospective evaluation. Diabetes Metab Res Rev 2021; 37:e3354. [PMID: 32484298 PMCID: PMC7300447 DOI: 10.1002/dmrr.3354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
AIMS COVID-19 is especially severe for elderly subjects with cardiometabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients. MATERIALS AND METHODS We prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from 25 March to 7 April 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission. RESULTS We enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260-per 1 cm increase 95% CI:1.120-1.417; P < .001), with a stronger association in the subgroup with BMI ≤30 Kg/m2 (adjusted OR 1.526; 95% CI:1.243-1.874; P < .001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < .001). In particular, NC > 40.5 cm (>37.5 for females and >42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test: P < .001). CONCLUSIONS NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.
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Affiliation(s)
- Stefano Di Bella
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Roberto Cesareo
- UOS Malattie MetabolicheSanta Maria Goretti HospitalLatinaItaly
| | | | - Andrea Palermo
- Unit of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Erik Roman‐Pognuz
- Department of Perioperative Medicine, Intensive Care and EmergencyUniversity HospitalTriesteItaly
| | - Verena Zerbato
- Infectious Diseases DepartmentUniversity of UdineUdineItaly
| | - Silvia Manfrini
- Unit of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | | | - Eugenia Dal Bo
- Azienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung DiseaseAOU “Policlinico‐Vittorio Emanuele”, Department of Clinical and Experimental MedicineCataniaItaly
| | - Elisabetta Macchini
- Department of Perioperative Medicine, Intensive Care and EmergencyUniversity HospitalTriesteItaly
| | - Francesco Quintavalle
- Department of Perioperative Medicine, Intensive Care and EmergencyUniversity HospitalTriesteItaly
| | - Giuseppe Campagna
- Department of Internal MedicineSanta Maria Goretti HospitalLatinaItaly
| | - Renato Masala
- Department of Internal MedicineSanta Maria Goretti HospitalLatinaItaly
| | - Luigi Ottaviani
- Department of Internal MedicineSanta Maria Goretti HospitalLatinaItaly
| | - Cosmo Del Borgo
- Infectious Diseases UnitSanta Maria Goretti HospitalLatinaItaly
| | - Lorenzo Ridola
- Department of Translational and Precision Medicine“Sapienza” University of RomeRomeItaly
| | - Frida Leonetti
- Diabetes Unit, Department of Medical‐Surgical Sciences and BiotechnologiesSanta Maria Goretti Hospital, Sapienza University of RomeLatinaItaly
| | - Giorgio Berlot
- Department of Perioperative Medicine, Intensive Care and EmergencyUniversity HospitalTriesteItaly
| | - Roberto Luzzati
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
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23
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Bernardi S, Giudici F, Cesareo R, Antonelli G, Cavallaro M, Deandrea M, Giusti M, Mormile A, Negro R, Palermo A, Papini E, Pasqualini V, Raggiunti B, Rossi D, Sconfienza LM, Solbiati L, Spiezia S, Tina D, Vera L, Stacul F, Mauri G. Five-Year Results of Radiofrequency and Laser Ablation of Benign Thyroid Nodules: A Multicenter Study from the Italian Minimally Invasive Treatments of the Thyroid Group. Thyroid 2020; 30:1759-1770. [PMID: 32578498 DOI: 10.1089/thy.2020.0202] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Radiofrequency ablation (RFA) and laser ablation (LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth, and retreatment over 5 years after RFA or LA and to identify predictive factors of outcome. Methods: In this multicenter retrospective study, the rates of technique efficacy, regrowth, and retreatment were evaluated in 406 patients treated with either RFA or LA, and followed for 5 years after initial treatment. Propensity score matching was used to compare treatments. Cumulative incidence studies with hazard models were used to describe regrowth and retreatment trends, and to identify prognostic factors. Logistic regression models and receiver operating characteristic analyses were used for risk factors and their cutoffs. Results: RFA and LA significantly reduced benign thyroid nodule volume, and this reduction was generally maintained for 5 years. Technique efficacy (defined as a reduction ≥50% after 1 year from the treatment) was achieved in 74% of patients (85% in the RFA and 63% in the LA group). Regrowth occurred in 28% of patients (20% in the RFA and 38% in the LA group). In the majority of cases, further treatment was not required as only 18% of patients were retreated (12% in the RFA and 24% in the LA group). These data were confirmed by propensity score matching. Cumulative incidence studies showed that RFA was associated with a lower risk of regrowth and a lower risk of requiring retreatment over time. Overall, technique inefficacy and regrowth were associated with low-energy delivery. Retreatments were more frequent in young patients, in large nodules, in patients with lower volume reduction at 1 year, and in cases of low-energy delivery (optimal cutoff was 918 J/mL for RFA). Conclusions: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules. The risk of regrowth and needing retreatment was lower after RFA. The need for retreatment was associated with young age, large baseline volume, and treatment with low-energy delivery.
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Affiliation(s)
- Stella Bernardi
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
- UO Medicina Clinica, Ospedale di Cattinara, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy
| | - Fabiola Giudici
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi di Padova, Padova, Italy
| | - Roberto Cesareo
- UO Malattie Metaboliche, Ospedale Santa Maria Goretti, Latina, Italy
| | - Giovanni Antonelli
- UO Chirurgia Endocrina e Ecoguidata, Ospedale del Mare, ASL Napoli1, Napoli, Italy
| | - Marco Cavallaro
- UO Radiologia, Ospedale Maggiore, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Massimo Giusti
- Dipartimento di Endocrinologia, AOU-IST IRCCS San Martino, Università degli Studi di Genova, Genova, Italy
| | - Alberto Mormile
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Roberto Negro
- UO Endocrinologia, Ospedale "V. Fazzi," Lecce, Italy
| | - Andrea Palermo
- Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Enrico Papini
- Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | | | - Bruno Raggiunti
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Duccio Rossi
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luigi Solbiati
- Dipartimento di Scienze Biomediche, Università Humanitas, Milano, Italy
| | - Stefano Spiezia
- UO Chirurgia Endocrina e Ecoguidata, Ospedale del Mare, ASL Napoli1, Napoli, Italy
| | - Doris Tina
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Lara Vera
- Dipartimento di Endocrinologia, AOU-IST IRCCS San Martino, Università degli Studi di Genova, Genova, Italy
| | - Fulvio Stacul
- UO Radiologia, Ospedale Maggiore, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy
| | - Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy
- Divisione di Radiologia Interventistica, IEO, IRCCS Istituto Europeo di Oncologia, Milano, Italy
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24
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Sambataro G, Giuffrè M, Sambataro D, Palermo A, Vignigni G, Cesareo R, Crimi N, Torrisi SE, Vancheri C, Malatino L, Colaci M, Del Papa N, Pignataro F, Roman-Pognuz E, Fabbiani M, Montagnani F, Cassol C, Cavagna L, Zuccaro V, Zerbato V, Maurel C, Luzzati R, Di Bella S. The Model for Early COvid-19 Recognition (MECOR) Score: A Proof-of-Concept for a Simple and Low-Cost Tool to Recognize a Possible Viral Etiology in Community-Acquired Pneumonia Patients during COVID-19 Outbreak. Diagnostics (Basel) 2020; 10:E619. [PMID: 32825763 PMCID: PMC7555441 DOI: 10.3390/diagnostics10090619] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
This study aims to assess the peripheral blood cell count "signature" of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) to discriminate promptly between COronaVIrus Disease 19 (COVID-19) and community-acquired pneumonia (CAP). We designed a retrospective case-control study, enrolling 525 patients (283 COVID-19 and 242 with CAP). All patients had a fever and at least one of the following signs: cough, chest pain, or dyspnea. We excluded patients treated with immunosuppressants, steroids, or affected by diseases known to modify blood cell count. COVID-19 patients showed a significant reduction in white blood cells (neutrophils, lymphocytes, monocytes, eosinophils) and platelets. We studied these parameters univariately, combined the significant ones in a multivariate model (AUROC 0.86, Nagelkerke PSEUDO-R2 0.5, Hosmer-Lemeshow p-value 0.9) and examined its discriminative performance in an internally-randomized validation cohort (AUROC 0.84). The cut-off selected according to Youden's Index (-0.13) showed a sensitivity of 84% and a specificity of 72% in the training cohort, and a sensitivity of 88% and a specificity of 73% in the validation cohort. In addition, we determined the probability of having COVID-19 pneumonia for each Model for possible Early COvid-19 Recognition (MECOR) Score value. In conclusion, our model could provide a simple, rapid, and cheap tool for prompt COVID-19 diagnostic triage in patients with CAP. The actual effectiveness should be evaluated in further, prospective studies also involving COVID-19 patients with negative nasopharyngeal swabs.
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Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
- Italian Liver Foundation, Basovizza, 34149 Trieste, Italy
| | - Domenico Sambataro
- Artroreuma S.R.L., Outpatient of Rheumatology Associated with the National Health System corso S. Vito 53, Mascalucia, 95030 Catania, Italy;
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Giovanna Vignigni
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Roberto Cesareo
- Unit of Metabolic Diseases, “S.M. Goretti” Hospital, 04100 Latina, Italy;
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Sebastiano Emanuele Torrisi
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Nicoletta Del Papa
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy; (N.D.P.); (F.P.)
| | - Francesca Pignataro
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy; (N.D.P.); (F.P.)
| | - Erik Roman-Pognuz
- Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, 34151 Trieste, Italy;
| | - Massimiliano Fabbiani
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
| | - Francesca Montagnani
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Chiara Cassol
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico San Matteo Foundation, Lombardia, 27100 Pavia, Italy;
| | - Valentina Zuccaro
- Infectious Diseases Clinic, University and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy;
| | - Verena Zerbato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Cristina Maurel
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Roberto Luzzati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
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Palermo A, Naciu AM, Tabacco G, Falcone S, Santonati A, Maggi D, D'Onofrio L, Briganti SI, Castellitto D, Casini A, Pedone C, Lelli D, Fabbri A, Bilezikian JP, Napoli N, Pozzilli P, Manfrini S, Cesareo R. Clinical, Biochemical, and Radiological Profile of Normocalcemic Primary Hyperparathyroidism. J Clin Endocrinol Metab 2020; 105:5818374. [PMID: 32271382 DOI: 10.1210/clinem/dgaa174] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT The clinical and radiological aspects of normocalcemic hyperparathyroidism (NHPT) are confounded by the differing methods used to rule out secondary hyperparathyroidism and by the small sample size. OBJECTIVE To assess the clinical, biochemical, and radiological profile of NHPT compared with primary hyperparathyroidism (PHPT) and control subjects. DESIGN Multicentric cross-sectional study. SETTING Outpatient clinic. PATIENTS 47 NHPT, 41 PHPT, and 39 age- and sex-matched control subjects. MAIN OUTCOME MEASURES Calcium metabolism and bone turnover markers (BTMs). Lumbar spine, total hip, femoral neck, one-third distal radius bone mineral density (BMD). Morphometric vertebral fracture (VF) assessed by dual-energy X-ray absorptiometry. RESULTS NHPT patients had significantly higher parathyroid hormone, 25(OH)-vitamin D levels and lower calcium × phosphorus product than controls (P < .001). Compared with PHPT, the NHPT group had significantly higher 25(OH) vitamin D levels (P = .016). NHPT had BTM levels similar to controls and PHPT. NHPT, PHPT, and controls have similar lumbar spine and femoral neck BMD. NHPT and controls had a similar radial BMD, while patients with PHPT had a lower radial BMD than both patients with NHPT (P = .031) and controls (P < .05). Using the control group as the reference, after adjustment for interacting factors, there was no increase in risk of moderate-severe VF in NHPT (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.25-4.55), while PHPT had an increased risk (OR 3.81,95% CI 1.15-15.12). Seventy-nine percent of NHPT and 59% of PHPT patients fulfilled the criteria for asymptomatic hyperparathyroidism. CONCLUSIONS The biochemical phenotype of NHPT is intermediate between PHPT and controls. In contrast, the bone phenotype resembles controls with normal bone turnover, no significant BMD impairment, and no increased risk of VF.
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Affiliation(s)
- Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Stefania Falcone
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Daria Maggi
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Alessandro Casini
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Claudio Pedone
- Geriatric Unit, University Campus Bio-Medico, Rome, Italy
| | - Diana Lelli
- Geriatric Unit, University Campus Bio-Medico, Rome, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, New York
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
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26
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Cesareo R, Pacella CM, Pasqualini V, Campagna G, Iozzino M, Gallo A, Lauria Pantano A, Cianni R, Pedone C, Pozzilli P, Taffon C, Crescenzi A, Manfrini S, Palermo A. Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial). Thyroid 2020; 30:847-856. [PMID: 32056501 DOI: 10.1089/thy.2019.0660] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: No direct prospective studies comparing laser ablation (LA) and radiofrequency ablation (RFA) for debulking benign non-functioning thyroid nodules (BNTNs) exist. We aimed at comparing the efficacy and safety of both techniques in patients with solid or predominantly solid BNTN. Methods: This six-month, single-use, randomized, open-label, parallel trial compared the following primary endpoints between the RFA and LA groups six months after treatment: (i) nodule volume reduction expressed as a percentage of nodule volume at baseline; (ii) proportion of nodules with more than 50% reduction (successful rate). We enrolled subjects with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems or patients without symptoms who experienced a volume increase >20% in one year. Nodules underwent core needle biopsy for diagnosis. Patients were randomly assigned (1:1) to receive LA or RFA. Safety was assessed in all randomly assigned participants. Results: Sixty patients were randomly assigned to receive either RFA or LA (1:1) between January 2016 and November 2018. Both groups were similar in basal nodule volume, thyroid function, histology, symptoms/cosmetic score, and procedure time. At six months, the nodule volume reduction was 64.3% (95% confidence interval, CI 57.5-71.2) in the RFA group and 53.2% ([CI 47.2-95.2]; p = 0.02) in the LA group. This effect was also confirmed in the linear regression model adjusted for age, baseline volume, and proportion of cellular component (LA vs. RFA percent change Delta = -12.8, p = 0.02). No significant difference was observed in success rate six months after treatment (RFA vs. LA: 86.7% vs. 66.7%, p = 0.13) or in thyrotropin level between the groups. Although improved, no significant difference was observed between RFA and LA for compressive symptoms (RFA: 2.13 vs. 3.9, p < 0 · 001; LA: 2.4 vs. 3.87, p < 0.001) and cosmetic score (RFA: 1.65 vs. 2.2, p < 0.001; LA: 1.85 vs. 2.2, p < 0.001). The adverse event rates (local pain, dysphonia, thyrotoxicosis, fever, hematoma) were 37% (n = 11) and 43% (n = 13) for RFA and LA, respectively, with no requirement for hospitalization. Conclusion: Although the success rate was similar in the RFA and LA groups, RFA achieved a significantly larger nodule volume reduction at six months.
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Affiliation(s)
- Roberto Cesareo
- Unit of Metabolic Diseases, "S.M. Goretti" Hospital, Latina, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | | | - Giuseppe Campagna
- Department of Internal Medicine, "S.M. Goretti" Hospital, Latina, Italy
| | - Mario Iozzino
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Andrea Gallo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Cianni
- Department of Interventional Radiology, S. Camillo Hospital, Rome, Italy
| | - Claudio Pedone
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Chiara Taffon
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
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27
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Cesareo R, Iwanczyk J, Bustamante A, Anjos MD, de Assis JT, Azeredo S, Lopes R. Transmission of X and γ-rays to differentiate tumbaga from gold and gilded copper. Microchem J 2020. [DOI: 10.1016/j.microc.2020.104720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Cesareo R, Pacella CM, Pasqualini V, Campagna G, Iozzino M, Gallo A, Pantano AL, Cianni R, Pedone C, Pozzilli P, Taffon C, Crescenzi A, manfrini S, Palermo A. OR18-07 Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomised, Parallel, Open-Label, Trial (Lara Trial). J Endocr Soc 2020. [PMCID: PMC7207726 DOI: 10.1210/jendso/bvaa046.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT Background: Up to now, there are no direct prospective studies comparing Laser (LA) and radiofrequency ablation (RFA). We aimed to compare, in a head- to-head clinical trial, the efficacy and safety of both techniques in a population affected by solid or predominantly solid benign non-functioning thyroid nodules (BNTN). Methods. LARA is a six-month, single-use, randomized, superiority, open-label, parallel trial. We enrolled subjects with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems or patients without symptoms who experienced a volume increase >20% in one year. Nodules underwent core needle biopsy (CNB) to evaluate the histological architecture. Patients were randomly assigned (1:1) to receive treatment with either LA or RFA. The primary endpoint was to evaluate the difference in nodule volume reduction between the RF and the LA group at six months. Moreover, we aimed to assess the differences between groups in the rate of nodules with greater than 50% base volume reduction (successful rate) at six months after treatment. ClinicalTrials.gov: number NCT02714946. Findings: From January 2016 to November 2018, 60 patients were randomly assigned (30 participants per group). In the whole study population, the average volume of nodules was 25 ml. The two groups were similar in terms of basal nodule volume, thyroid function, histology, symptoms/cosmetic score and procedure time. At six months, participants in the RFA group showed a reduction volume of 64·3% (95% CI: 57·5% - 71·2%) compared to 53·2% (95% CI: 47·2% - 59·2%) in the LA group (p= 0·015) and this difference was also confirmed in a linear regression model adjusted for age, baseline volume and proportion of cellular component (Laser vs. RFA percent change Delta= -12·8, P=0·018).We have not recorded any significant difference in terms of successful rate at six months after treatment between the two groups (86·7% in the RFA vs 66·7% in the LA, p=0·127). At six months, both symptoms and cosmetic scores improved (compressive symptom score: 2·13 vs 3·9 for RFA, p < 0·001; 2·4 vs. 3·87 for LA, p < 0·001; cosmetic score: 1·65 vs 2·2 for RFA p <0·001, 1·85 vs 2·2 for LA p <0·001) without any statistically significant difference between the two groups. No statistical difference between the two groups was detected at six months as regards the TSH level. High rate of cellularity negatively affects the volume reduction in RFA group (r coefficient -0·41, p=0·034) while histological features did not affect the efficacy of the LA. The adverse event rates were 37% and 43% for RFA and LA, respectively, with no requirement for hospitalization. Interpretation: Both techniques are very effective in reducing the volume of thyroid nodules. RFA appears to be more effective than LA, but both techniques showed no difference in terms of success rate six months after treatment. The safety of the two techniques is very satisfactory.
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29
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Barcellos Lins SA, Ridolfi S, Gigante GE, Cesareo R, Albini M, Riccucci C, di Carlo G, Fabbri A, Branchini P, Tortora L. Differential X-Ray Attenuation in MA-XRF Analysis for a Non-invasive Determination of Gilding Thickness. Front Chem 2020; 8:175. [PMID: 32232028 PMCID: PMC7083071 DOI: 10.3389/fchem.2020.00175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
When investigating gilded artifacts or works of art, the determination of the gilding thickness plays a significant role in establishing restoration protocols or conservation strategies. Unfortunately, this is done by cross-sectioning the object, a destructive approach not always feasible. A non-destructive alternative, based on the differential attenuation of fluorescence radiation from the sample, has been developed in the past years, but due to the intrinsic random nature of X-rays, the study of single or few spots of an objects surface may yield biased information. Furthermore, considering the effects of both porosity and sample inhomogeneities is a practice commonly overlooked, which may introduce systematic errors. In order to overcome these matters, here we propose the extrapolation of the differential-attenuation method from single-spot X-ray fluorescence (XRF) measurements to macro-XRF (MA-XRF) scanning. In this work, an innovative algorithm was developed for evaluating the large amount of data coming from MA-XRF datasets and evaluate the thickness of a given overlapping layer over an area. This approach was adopted to study a gilded copper-based buckle from the sixteenth to seventeenth century found in Rome. The gilded object under investigation was also studied by other analytical techniques including scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS). Previous results obtained from SEM-EDS were used to confront the data obtained with the proposed methodology and validate it. MA-XRF elemental distribution maps were fundamental in identifying and choosing sampling areas to calculate the thickness of the gilding layer, avoiding lead islands present in the sample that could negatively influence the results. Albeit the large relative standard deviation, the mean thickness values fell within those found in literature and those obtained from previous studies with SEM-EDS. Surface fissure has been found to deeply affect the results obtained, an aspect that is often disregarded.
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Affiliation(s)
- Sergio Augusto Barcellos Lins
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Rome, Italy.,Surface Analysis Laboratory, Istituto Nazionale di Fisica Nucleare Sezione di Roma Tre, Rome, Italy
| | | | - Giovanni Ettore Gigante
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Rome, Italy
| | - Roberto Cesareo
- Istituto di Matematica e Fisica, Università degli Studi di Sassari, Sassari, Italy
| | - Monica Albini
- Institute for the Study of Nanostructured Materials, National Research Council, Rome, Italy
| | - Cristina Riccucci
- Institute for the Study of Nanostructured Materials, National Research Council, Rome, Italy
| | - Gabriella di Carlo
- Institute for the Study of Nanostructured Materials, National Research Council, Rome, Italy
| | - Andrea Fabbri
- Surface Analysis Laboratory, Istituto Nazionale di Fisica Nucleare Sezione di Roma Tre, Rome, Italy
| | - Paolo Branchini
- Surface Analysis Laboratory, Istituto Nazionale di Fisica Nucleare Sezione di Roma Tre, Rome, Italy
| | - Luca Tortora
- Surface Analysis Laboratory, Istituto Nazionale di Fisica Nucleare Sezione di Roma Tre, Rome, Italy.,Department of Sciences, Roma Tre University, Rome, Italy
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30
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di Masi A, Leboffe L, Sodo A, Tabacco G, Cesareo R, Sbroscia M, Giovannoni I, Taffon C, Crucitti P, Longo F, Manfrini S, Ricci MA, Ascenzi P, Crescenzi A, Palermo A. Metabolic profile of human parathyroid adenoma. Endocrine 2020; 67:699-707. [PMID: 31786773 DOI: 10.1007/s12020-019-02146-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Recently, it has been demonstrated that Raman spectroscopy is able to differentiate between healthy parathyroid tissues and parathyroid adenoma based on the basis of a specific molecular fingerprint. However, to our knowledge, no previous studies have been performed to evaluate the metabolic profile of parathyroid adenoma. Therefore, we designed a proof of concept study aimed to investigate the glucose/fatty acid metabolisms, in addition to the mitochondrial changes, in solitary parathyroid adenoma and in healthy parathyroid glands. METHODS Nine females with primary hyperparathyroidism due to a solitary parathyroid adenoma and formal surgical indication for parathyroidectomy have been enrolled. At the time of surgery, the removed specimens were immediately submitted unfixed and a tissue slice of about 0.5 cm in diameter was obtained from the nodular lesion. The expression of selected metabolic enzymes and proteins has been evaluated by western blot analysis, using human parathyroid whole tissue lysates as control. RESULTS Data obtained highlighted an increase, compared with the healthy group, of: (i) the glucose uptake by the GLUT-1 receptor and its phosphorylation by hexokinase II (HXKII); (ii) the expression of 3-phosphoglycerate dehydrogenase (3-PGDH) and glucose-6-phosphate dehydrogenase (G6PD); (iii) lipids biosynthesis; and (iv) cytochrome c expression. CONCLUSIONS Our findings highlight for the first time the parathyroid adenoma metabolic hallmarks that could represent potential molecular targets usable for the development of new pharmacological treatments, allowing to reduce surgical parathyroidectomy.
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Affiliation(s)
| | - Loris Leboffe
- Department of Sciences, Roma Tre University, I-00146, Roma, Italy
| | - Armida Sodo
- Department of Sciences, Roma Tre University, I-00146, Roma, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Roma, Italy
| | - Roberto Cesareo
- Unit of Metabolic Diseases, Department of Internal Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Marco Sbroscia
- Department of Sciences, Roma Tre University, I-00146, Roma, Italy
| | | | - Chiara Taffon
- Pathology Unit, Campus Bio-Medico University Hospital, Roma, Italy
| | | | - Filippo Longo
- Unit of Neck and Chest Surgery, Campus Bio-Medico University, Roma, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Roma, Italy
| | | | - Paolo Ascenzi
- Department of Sciences, Roma Tre University, I-00146, Roma, Italy
| | - Anna Crescenzi
- Pathology Unit, Campus Bio-Medico University Hospital, Roma, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Roma, Italy
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31
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Cesareo R, Palermo A, Pasqualini V, Manfrini S, Trimboli P, Stacul F, Fabris B, Bernardi S. Radiofrequency Ablation on Autonomously Functioning Thyroid Nodules: A Critical Appraisal and Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:317. [PMID: 32528412 PMCID: PMC7256164 DOI: 10.3389/fendo.2020.00317] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Thyroid nodules are an extremely common occurrence, as their prevalence in the general population is estimated to range between 50 and 70%. Some of these nodules are autonomously functioning such that they can cause hyperthyroidism over time. In this case, surgery and radioiodine represent the standard of care. Nevertheless, patients might have contraindications or be unwilling to undergo these treatments. Minimally-invasive ultrasound-guided techniques, such as laser and radiofrequency ablation (RFA), have been recently introduced into clinical practice as an alternative treatment for symptomatic benign thyroid nodules. Due to their efficacy and tolerability, these techniques have become increasingly available and their usage has been extended also to autonomously functioning thyroid nodules (AFTN). Methods: In this narrative review, we will describe the studies reporting the therapeutic effects of RFA on AFTN, the studies reporting how RFA compares to the other treatment modalities, as well as the current indications for the use of RFA in patients with AFTN. For this purpose, a comprehensive literature search was independently conducted by three investigators on PubMed, EMBASE, and the Cochrane Library from inception up to February 2020 to identify published articles concerning the effects of RFA on AFTN. Results and Conclusions: Current consensus statements and guidelines support the notion that RFA should be regarded as a first-line therapy for non-functioning benign thyroid nodules, while it remains a valid second-line option for AFTN treatment in case of contraindications or patient unwillingness to undergo surgery or radioiodine.
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Affiliation(s)
- Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | | | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Disease, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università di Lugano (USI), Lugano, Switzerland
| | - Fulvio Stacul
- Unit of Radiology (Maggiore Hospital), ASUGI, Trieste, Italy
| | - Bruno Fabris
- Unit of Medicina Clinica (Cattinara Hospital), ASUGI, Trieste, Italy
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Stella Bernardi
- Unit of Medicina Clinica (Cattinara Hospital), ASUGI, Trieste, Italy
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- *Correspondence: Stella Bernardi
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32
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Trimboli P, Castellana M, Sconfienza LM, Virili C, Pescatori LC, Cesareo R, Giorgino F, Negro R, Giovanella L, Mauri G. Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: A systematic review and meta-analysis. Endocrine 2020; 67:35-43. [PMID: 31327158 DOI: 10.1007/s12020-019-02019-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Image-guided thermal ablations are commonly used in the treatment of thyroid nodules. Radiofrequency ablation (RFA) and laser ablation are the most commonly used. Here we aimed to obtain solid evidence of the long-term efficacy of RFA and laser ablation in benign non-functioning solid thyroid nodules (BNFSTN). METHODS PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019. Studies reporting the effectiveness of RFA or laser ablation in patients with BNFSTN in terms of volume reduction rate (VRR), compressive symptoms and cosmetic concerns were included. Complications were also assessed. RESULTS Out of 963 papers, 12 studies on RFA and 12 on laser ablation were included, assessing 1186 and 2009 BNFSTNs, respectively. Overall, VRR at 6, 12, 24, and 36 months was 60%, 66%, 62%, and 53%. VRR of RFA was 68%, 75%, and 87%, respectively. VRR of laser ablation was 48%, 52%, 45%, and 44%, respectively. Baseline volume of nodules undergone RFA was significantly smaller compared to laser ablation (20.1 ± 22.4 versus 24.6 ± 23.6 ml; p < 0.01). Nodules smaller than 30 ml obtained better outcomes than larger ones. A significant reduction in compressive symptoms and cosmetic concerns was found after RFA. CONCLUSIONS This meta-analysis showed that both RFA and laser ablation are able to obtain a significant volume reduction in BNFSTNs. A significant volume reduction is already evident at 6 months after thermal ablation and results are stable over the time.
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Affiliation(s)
- Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Castellana
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
- IRCCS Istituto Ortopedico Galeazzi, Unit of Diagnostic and Interventional Radiology, Milano, Italy.
| | - Camilla Virili
- Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Roberto Cesareo
- Unit of Metabolic Diseases, S.M.Goretti, Latina Hospital, Latina, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology IRCCS, Milan, Italy
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Trimboli P, Castellana M, Sconfienza LM, Virili C, Pescatori LC, Cesareo R, Giorgino F, Negro R, Giovanella L, Mauri G. Thermal ablation meta-analysis: the need of careful appraisal of meta-analysis methodology. Endocrine 2020; 67:270-271. [PMID: 31659630 DOI: 10.1007/s12020-019-02122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - Marco Castellana
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Camilla Virili
- Science and Medico-Surgical Biotechnologies, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Cesareo
- Thyroid and Metabolic Bone Diseases Center, Ospedale Santa Maria Goretti, Latina, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology IRCCS, Milan, Italy
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Tabacco G, Naciu AM, Cesareo R, Maggi D, Pedone C, Lelli D, Santonati A, Bosco D, Di Tommaso AM, Pozzilli P, Manfrini S, Palermo A. Cardiovascular autonomic neuropathy as a cause of fatigue in chronic hypoparathyroidism. Endocrine 2020; 67:198-203. [PMID: 31583574 DOI: 10.1007/s12020-019-02101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Hypoparathyroidism (hypoPT) results in an impairment of quality of life (QoL), an increase in fatigue and a higher risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system and is associated with increased mortality and fatigability. Patients with hypoPT show an increased risk of CAN. However, no previous studies have investigated the association between CAN and QoL in hypoPT. To test whether CAN is associated with fatigue and impaired QOL in hypoPT patients. METHODS We enrolled 48 subjects with postsurgical hypoPT treated with calcium and calcitriol and 38 healthy subjects who underwent thyroidectomy. Subjects completed the RAND 36-Item Short Form (SF-36) Health Survey, evaluating physical (PCS) and mental (MCS) health, and fatigue score. CAN was assessed using cardiovascular autonomic reflex tests (CARTs). Participants were considered to have "early CAN" (EC) if they had one abnormal CART and "definite CAN" (DC) with two or more abnormal CARTs. RESULTS Compared with controls, hypoPT population had lower fatigue scores (44.5 IQRː9 vs 38.5 IQRː12.3, P = 0.031). In the hypoPT group, only participants with DC had a lower fatigue score than subjects without CAN (DC: β: -9.55, P = 0.005) after adjusting for age, duration of disease, calcium concentration, TSH, calcitriol and calcium supplementation. No differences were found in the PCS and MCS scores in the hypoPT group. CONCLUSIONS CAN may explain fatigue, a common complaint of postsurgical hypoPT patients. Further larger and prospective investigations are needed to confirm our findings.
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Affiliation(s)
- Gaia Tabacco
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Roberto Cesareo
- Thyroid and Metabolic Bone Diseases Center, Department of Internal Medicine, S. Maria Goretti Hospital, 04100, Latina, Italy
| | - Daria Maggi
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatric, University Campus Bio-Medico, 00128, Rome, Italy
| | - Diana Lelli
- Unit of Geriatric, University Campus Bio-Medico, 00128, Rome, Italy
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, 00184, Rome, Italy
| | - Daniela Bosco
- Department of Endocrinology, San Giovanni Addolorata Hospital, 00184, Rome, Italy
| | - Alfonso Maria Di Tommaso
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy.
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Palermo A, Sanesi L, Colaianni G, Tabacco G, Naciu AM, Cesareo R, Pedone C, Lelli D, Brunetti G, Mori G, Colucci S, Manfrini S, Napoli N, Grano M. A Novel Interplay Between Irisin and PTH: From Basic Studies to Clinical Evidence in Hyperparathyroidism. J Clin Endocrinol Metab 2019; 104:3088-3096. [PMID: 30759249 DOI: 10.1210/jc.2018-02216] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/08/2019] [Indexed: 02/11/2023]
Abstract
CONTEXT Irisin is a hormonelike molecule that is cleaved and secreted by an unknown protease from fibronectin type III domain-containing protein 5 (FNDC5). It ameliorates bone status and muscle atrophy and influences energy homeostasis. PTH exerts several metabolic effects that may interact with the effects of irisin. OBJECTIVES To test the hypothesis that irisin and PTH mutually affect their biological action, we evaluated FNDC5 mRNA and protein expression in myotubes treated with PTH (1-34) and parathyroid hormone receptor (PTH-r) mRNA expression in osteoblasts treated with r-irisin. To confirm the in vivo impact of PTH on irisin, we compared irisin serum concentrations in postmenopausal women with primary hyperparathyroidism (PHPT) and control subjects. DESIGN AND INTERVENTION C2C12 myotubes were treated with short-term and continuous 10-10 M teriparatide and MC3T3-E1 osteoblasts with 100 ng/mL r-irisin for 8 hours. In a cross-sectional open-label trial, we enrolled 26 postmenopausal women with PHPT and 31 age-/body mass index (BMI)‒matched control subjects without impairment of calcium/phosphate metabolism. RESULTS Teriparatide treatment on myotubes significantly downregulated FNDC5 expression by acting through its own receptor, which in turn activated Erk11/2 phosphorylation. r-Irisin led to a 50% downregulation of PTH-r mRNA expression compared with untreated cells (P < 0.001). Irisin was significantly lower in the PHPT group than in age-/BMI-matched controls (4.5 ± 1.1 vs 12 ± 5.2 µg/mL; P < 0.001). No significant correlation between irisin and bone mineral density or PTH was recorded in the PHPT group. CONCLUSION Preclinical findings suggest the existence of an interplay between PTH and irisin metabolism that seems to be confirmed by the significant reduction of irisin concentration in postmenopausal women with PHPT.
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Affiliation(s)
- Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Lorenzo Sanesi
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Graziana Colaianni
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Claudio Pedone
- Unit of Geriatric, University Campus Bio-Medico, Rome, Italy
| | - Diana Lelli
- Unit of Geriatric, University Campus Bio-Medico, Rome, Italy
| | - Giacomina Brunetti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, University of Bari, Bari, Italy
| | - Giorgio Mori
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Silvia Colucci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, University of Bari, Bari, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Maria Grano
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Cesareo R, Falchetti A, Attanasio R, Tabacco G, Naciu AM, Palermo A. Hypovitaminosis D: Is It Time to Consider the Use of Calcifediol? Nutrients 2019; 11:E1016. [PMID: 31064117 PMCID: PMC6566727 DOI: 10.3390/nu11051016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022] Open
Abstract
Hypovitaminosis D is becoming a notable health problem worldwide. A consensus exists among several different medical societies as to the need for adequate levels of vitamin D for bone and general health. The correct method by which to restore normal vitamin D levels is still a matter of debate. Although cholecalciferol remains the most commonly distributed form of vitamin D supplementation worldwide, several drugs with vitamin D activity are available for clinical use, and making the correct selection for the individual patient may be challenging. In this narrative review, we aim to contribute to the current knowledge base on the possible and appropriate use of calcifediol-the 25-alpha-hydroxylated metabolite-in relation to its chemical characteristics, its biological properties, and its pathophysiological aspects. Furthermore, we examine the trials that have aimed to evaluate the effect of calcifediol on the restoration of normal vitamin D levels. Calcifediol is more soluble than cholecalciferol in organic solvents, due to its high polarity. Good intestinal absorption and high affinity for the vitamin-D-binding protein positively affect the bioavailability of calcifediol compared with cholecalciferol. In particular, orally administered calcifediol shows a much shorter half-life than oral cholecalciferol. Most findings suggest that oral calcifediol is about three- to five-fold more powerful than oral cholecalciferol, and that it has a higher rate of intestinal absorption. Accordingly, calcifediol can be particularly useful in treating diseases associated with decreased intestinal absorption, as well as obesity (given its lower trapping in the adipose tissue) and potentially neurological diseases treated with drugs that interfere with the hepatic cytochrome P-450 enzyme system, resulting in decreased synthesis of calcifediol. Up to now, there has not been enough clinical evidence for its use in the context of osteoporosis treatment.
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Affiliation(s)
- Roberto Cesareo
- Unit of Metabolic Diseases, Department of Internal Medicine, S. Maria Goretti Hospital, 04100 Latina, Italy.
| | - Alberto Falchetti
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research; University of Milan, and EndOsMet, Villa Donatello Private Hospital, 50100 Florence, Italy.
| | - Roberto Attanasio
- Endocrinology Service, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy.
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, 00128 Rome, Italy.
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, 00128 Rome, Italy.
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, 00128 Rome, Italy.
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Tabacco G, Naciu A, Maggi D, Pedone C, Lelli D, Santonati A, Bosco D, Cesareo R, Di Tommaso A, NAPOLI NICOLA, Pozzilli P, Manfrini S, Palermo A. MON-527 Cardiovascular Autonomic Neuropathy As A Cause Of Quality Of Life Impairment In Subjects With Chronic Hypoparathyroidism. J Endocr Soc 2019. [PMCID: PMC6550690 DOI: 10.1210/js.2019-mon-527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Post-surgical hypoparathyroidism (hypoPT) increases fatigue and seems to affect the risk of mortality. Hypoparathyroid patients on conventional treatment with calcium and vitamin D supplementation show a reduction of Quality of life (QoL). Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system and it represents a cause of increased mortality and fatigability. Recently, we have demonstrated that patient with chronic post-surgical hypoparathyroidism show an increased risk of CAN. No previous studies have investigated the association between CAN and QoL in hypoparathyroidism. Aim: We tested the hypothesis that CAN would be associated with impaired QOL measures in subjects with chronic post-surgical hypoparathyroidism. Study population and design: We enrolled 49 post-surgical hypoparathyroid patients treated with calcium and calcitriol. Subjects completed the RAND 36-Item Short Form (SF-36) Health Survey, a measure of health-related QOL covering eight domains of physical and mental health. QOL has also been evaluated using Fatigue score (version 4). CAN was assessed by heart rate (HR) response to deep breathing, HR response to the lying-to-standing test, HR response to the Valsalva maneuver and blood pressure response to standing. Participants were considered to have “early CAN” (EC) if they had one abnormal result in the HR tests and “definite CAN” (DC) with two or more abnormal results. Results: the prevalence of EC was 39% (n=19), the prevalence of DC was 39% (n=19), the prevalence of patients without CAN (WC) was 22% (n=11). Only DC subjects had a statistically significant lower fatigue score compared to WC(35.1±5.8 vs 44.4±4.6, P=0.004). These results have been confirmed after adjustment for age, calcium concentration, calcitriol and calcium supplementation (β:-9.31, P=0.004). No statistically significant differences between groups were found for mental and physical component summary scores. Role limitation due to physical problem represents the only domain that showed a significant reduction between groups (WC: 82.6±33.4, EC: 72.4±33.2, DC: 50±38.2, ANOVA P=0.044). Conclusion: definite CAN may represent a cause of impaired QoL in patient with chronic post-surgical hypoparathyroidism. The presence of cardiovascular autonomic neuropathy could explain the fatigue, a common complaint in patient with hypoparathyroidism.
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Affiliation(s)
- Gaia Tabacco
- University Campus Biomedico of Rome, Rome, , Italy
| | - Anda Naciu
- University Campus Biomedico of Rome, Rome, , Italy
| | - Daria Maggi
- University Campus Biomedico of Rome, Rome, , Italy
| | | | - Diana Lelli
- University Campus Biomedico of Rome, Rome, , Italy
| | | | | | | | | | | | - Paolo Pozzilli
- Endocrinology, Università Campus Bio Medico, Rome, , Italy
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Palermo A, Sanesi L, Colaianni G, Tabacco G, Naciu AM, Cesareo R, Pedone C, Lelli D, Brunetti G, Mori G, Colucci S, Manfrini S, Napoli N, Grano M. MON-533 Irisin in Post-Menopausal Women with Primary Hyperparathyroidism: An Interplay between Irisin and Pth. J Endocr Soc 2019. [PMCID: PMC6550560 DOI: 10.1210/js.2019-mon-533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Irisin is a myokine able to ameliorate bone status, muscle atrophy and it influences also glucose and energy homeostasis. PTH is hormone able to exert several metabolic effects that may interact with irisin’s ones. No studies have investigated the biological relation between Irisin and PTH. Aim:To test the hypothesis that irisin and PTH mutually affect their biological action, we evaluated the FNDC5 mRNA expression in myotubes treated with PTH (1-34) and PTH-R mRNA expression in osteoblast treated with recombinant irisin. To confirm the in vivoimpact of PTH on irisin, we evaluated irisin serum concentration in post-menopausal women with primary hyperparathyroidism (PHPT) compared to age, sex and BMI matched control subjects with no impairment of calcium/phosphate metabolism. Methods: C2C12 myotubes were treated with 100nM of teriparatide for 3 and 8 hours or with 100nM of teriparatide for 6 days, refreshing medium every 48h. MC3T3-E1 osteoblastswere treated with 100 ng/ml r-Irisin for 8 hours. Teriparatide-treated myotubes, Irisin-treated osteoblasts and untreated controls were subjected to RNA extraction and qPCR analysis. In a cross-sectional, open-label trial, we enrolled 26 PHPT post-menopausal women and 31 age/BMI matched control subjects with no impairment of calcium/phosphate metabolism. Results:Both short (p=0.036) and continuous (p=0.006) teriparatide treatment on myotubes significantly decreased FNDC5 mRNA expression respect to untreated control. r-Irisinled to a 50% down regulation of PTH-R mRNA expression compared to untreated cell (p=0.029).Irisin was significantly lower in PHPT group compared to age/BMI-matched controls (4.5±1.1 vs 12±5.2 µg/mL, p<0.001). No significant correlation between Irisin and BMD or PTH was recorded in PHPT group. Conclusion: for the first time, our pre-clinical findings suggest the existence of interplay between PTH and irisin metabolism that seems to be confirmed by the significant reduction of irisin concentration in post-menopausal women with PHPT.
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Affiliation(s)
| | | | | | - Gaia Tabacco
- University Campus Bio-Medico, Roma, Rome, , Italy
| | | | | | | | - Diana Lelli
- University Campus Bio-Medico, Roma, Rome, , Italy
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Papini E, Pacella CM, Solbiati LA, Achille G, Barbaro D, Bernardi S, Cantisani V, Cesareo R, Chiti A, Cozzaglio L, Crescenzi A, De Cobelli F, Deandrea M, Fugazzola L, Gambelunghe G, Garberoglio R, Giugliano G, Luzi L, Negro R, Persani L, Raggiunti B, Sardanelli F, Seregni E, Sollini M, Spiezia S, Stacul F, Van Doorne D, Sconfienza LM, Mauri G. Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group. Int J Hyperthermia 2019; 36:376-382. [PMID: 30909759 DOI: 10.1080/02656736.2019.1575482] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).
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Affiliation(s)
- Enrico Papini
- a Dipartimento di Endocrinologia , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Claudio Maurizio Pacella
- b Dipartimento di Imaging Diagnostico e Radiologia Interventistica , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Luigi Alessandro Solbiati
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Gaetano Achille
- e Unità Operativa ORL, IRCCS Oncologico "Giovanni Paolo II" , Bari , Italy
| | - Daniele Barbaro
- f U.O. Endocrinologia ASL Nordovest Toscana , Toscana , Italy
| | - Stella Bernardi
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy.,h Università degli Studi di Trieste , Trieste , Italy
| | - Vito Cantisani
- i Policlinico Umberto I, Università Sapienza , Roma , Italy
| | - Roberto Cesareo
- j Thyroid and metabolic bone diseases center, Ospedale Santa Maria Goretti , Latina , Italy
| | - Arturo Chiti
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Luca Cozzaglio
- d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Anna Crescenzi
- k UOC Anatomia Patologica, Policlinico Universitario Campus Bio-Medico , Roma , Italy
| | | | | | - Laura Fugazzola
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Roberto Garberoglio
- q Ospedale Città della Salute Torino, Dipartimento Universitario di Endocrinologia e Malattie Metaboliche , Torino , Italy
| | - Gioacchino Giugliano
- r Department of Head and Neck , Istituto Europeo di Oncologia, IRCCS , Milano , Italy
| | - Livio Luzi
- o Università degli Studi di Milano , Milano , Italy.,s IRCCS Policlinico San Donato, UOC Endocrinologia e Malattie Metaboliche , San Donato Milanese , Italy
| | | | - Luca Persani
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Francesco Sardanelli
- o Università degli Studi di Milano , Milano , Italy.,v IRCCS Policlinico San Donato , San Donato Milanese , Italy
| | - Ettore Seregni
- w Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Stefano Spiezia
- x Unità Operativa di Chirurgia Endocrina ed Ecoguidata , Ospedale del Mare, ASL Napoli1 centro , Napoli , Italy
| | - Fulvio Stacul
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy
| | | | - Luca Maria Sconfienza
- o Università degli Studi di Milano , Milano , Italy.,z IRCCS Istituto Ortopedico Galeazzi , Milano , Italy
| | - Giovanni Mauri
- aa Division of Interventional Radiology , IEO, European Institute of Oncology IRCCS , Milan , Italy
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Tabacco G, Naciu AM, Maggi D, Santonati A, Pedone C, Cesareo R, Bosco D, Gaspa G, Napoli N, Pozzilli P, Manfrini S, Palermo A. Cardiovascular Autonomic Neuropathy as a New Complication of Postsurgical Chronic Hypoparathyroidism. J Bone Miner Res 2019; 34:475-481. [PMID: 30395692 DOI: 10.1002/jbmr.3623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022]
Abstract
Postsurgical hypoparathyroidism (hypoPT) increases fatigue and seems to affect the risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system, a cause of increased mortality, and associated with increased fatigability. The aim of this study is to evaluate CAN in hypoPT and its relationship with hypocalcemia, PTH levels, and hyperphosphatemia. This is a cross-sectional study comparing 51 postsurgical hypoPT patients treated with calcium and calcitriol and 43 control subjects without any PTH/calcium/phosphate disorders who underwent thyroidectomy. CAN was assessed by heart rate (HR) response to deep breathing, HR response to the lying-to-standing test, HR response to the Valsalva maneuver, and blood pressure response to standing. Participants were considered to have "early CAN" if they had one abnormal result in the HR tests and "definite CAN" with two or more abnormal results. The prevalence of CAN was 23% in the control group and 78% in the hypoPT group (OR 11.48; 95% CI, 4.48 to 32.17). Patients with hypoPT and serum calcium (sCa) ≥8.5 mg/dL had a prevalence of early CAN of 72.4% and the prevalence was 86.4% in those with sCa <8.5 mg/dL. Definite CAN was found in 2.3% of the control group, 24.1% of the hypoPT group without hypocalcemia, and 59.1% of the hypoPT group with hypocalcemia. In the hypoPT group, the OR for definite CAN in the patients with hypocalcemia compared to the patients with normocalcemia was 4.54 (95% CI, 1.36 to 15.11). The association between low sCa and definite CAN was confirmed after adjustment for confounders with OR 13.62 (95% CI, 2.12 to 149.84). No association was found between definite CAN and PTH levels or high phosphate levels. HypoPT is associated with CAN and hypocalcemia seems to affect its severity. Larger and prospective studies are needed to confirm our findings. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Gaia Tabacco
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Daria Maggi
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatric, University Campus Bio-Medico, Rome, Italy
| | - Roberto Cesareo
- Thyroid and Metabolic Bone Diseases Center, Santa Maria Goretti Hospital, Latina, Italy
| | - Daniela Bosco
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Gianluigi Gaspa
- Thyroid and Metabolic Bone Diseases Center, Santa Maria Goretti Hospital, Latina, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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Cesareo R, Palermo A, Benvenuto D, Cella E, Pasqualini V, Bernardi S, Stacul F, Angeletti S, Mauri G, Ciccozzi M, Trimboli P. Correction to: Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis. Rev Endocr Metab Disord 2019; 20:45. [PMID: 31028505 DOI: 10.1007/s11154-019-09499-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors of this paper declare that their correct family and first names and their correct affiliations are shown in this correction paper.
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Affiliation(s)
- Roberto Cesareo
- Thyroid and Metabolic Bone Diseases Center, Santa Maria Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology, University Campus Biomedico, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Eleonora Cella
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | | | - Stella Bernardi
- Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Fulvio Stacul
- Radiology Department, Maggiore Teaching Hospital, ASUITS, Trieste, Italy
| | - Silvia Angeletti
- UOC Laboratory Medicine, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Ciccozzi
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Cesareo R, Palermo A, Benvenuto D, Cella E, Pasqualini V, Bernardi S, Stacul F, Angeletti S, Mauri G, Ciccozzi M, Trimboli P. Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis. Rev Endocr Metab Disord 2019; 20:37-44. [PMID: 30887407 DOI: 10.1007/s11154-019-09487-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Whether thermal ablation is effective to treat toxic thyroid nodules (TTN) is still unknown. Aim of this review was to achieve more robust evidence on the efficacy of radiofrequency ablation (RFA) in treating TTN in terms of TSH normalization, thyroid scintiscan, and volume reduction rate (VRR). A comprehensive literature search of PubMed/Medline and Scopus was performed in November 2018 to retrieve published studies. Original papers reporting TTN treated by RFA and later followed-up were eligible. Excluded were: articles not within this field, articles with unclear data, overlapping series, case/series reports. Discordances were solved in a final collegial meeting. Information was collected concerning population features, treatment procedure, follow-up, cases with TSH normalization, cases with scintiscan normalization, VRR of nodules. Pooled prevalence of patients with TSH or scintiscan normalization, and pooled VRR over time were calculated. For statistical analysis, the random-effects model was used. Eight articles published between 2008 and 2018 were included. The overall number of AFTN treated by RFA was 205. Five studies used a single session of treatment. The time of follow-up ranged from six to 24 months. The pooled rate of patients with TSH normalization was 57%. The pooled rate of patients with scintigraphically proven optimal response was 60%. The pooled VRR at 1 year was 79%. Baseline nodules volume was associated with the rate of TSH normalization. In conclusion, a moderate efficacy of RFA in treating TTN was found, and this can represent a solid starting point in this field.
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Affiliation(s)
- Roberto Cesareo
- Thyroid and Metabolic Bone Diseases Center, Santa Maria Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology, University Campus Biomedico, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Eleonora Cella
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | | | - Stella Bernardi
- Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Fulvio Stacul
- Radiology Department, Maggiore Teaching Hospital, ASUITS, Trieste, Italy
| | - Silvia Angeletti
- UOC Laboratory Medicine, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Ciccozzi
- Unit of Medical statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Nardes R, Silva M, Rezier A, Sanches F, Gama Filho H, Santos R, Oliveira D, Lopes R, Carvalho M, Cesareo R, Zanatta E, Assis J, Anjos M. Study on Brazilian 18th century imperial carriage using x-ray nondestructive techniques. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
SummaryHalf-time values of platelets labelled with stable rubidium are compared to those of platelets labelled with Cr51. Platelets labelled with stable rubidium are assayed by a very simple version of the X-Ray fluorescence equipment. The mean quantity of rubidium incorporated by the cells is of about some µg Rb per ml blood.The in vitro half-time of human Rb labelled platelets stored at 22° C is 41.2 ± 3h compared with the value 44.8 ± 3h for platelets labelled with Cr51, as deduced by six experiments. The in vivo half-time of rabbit platelets labelled with stable rubidium is 22 ± 3h compared with the value 18 ± 3h of platelets labelled with Cr51; ten experiments were carried out.
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Affiliation(s)
- D Del Principe
- The I Department of Pediatrics, University of Rome, Italy
| | - R Cesareo
- The Istituto di Fisica, Facoltà di Ingegneria, University of Rome, Italy
| | - B M Tallarida
- The I Department of Pediatrics, University of Rome, Italy
| | - M G Ciancarelli
- The Cattedra di Fisiologia, L. Istituto di Medicina e Chirurgia, L'Aquila, Italy
| | - M Ricci
- The I Department of Pediatrics, University of Rome, Italy
| | - G Mancuso
- The I Department of Pediatrics, University of Rome, Italy
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Cesareo R, Attanasio R, Caputo M, Castello R, Chiodini I, Falchetti A, Guglielmi R, Papini E, Santonati A, Scillitani A, Toscano V, Triggiani V, Vescini F, Zini M. Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults. Nutrients 2018; 10:nu10050546. [PMID: 29702603 PMCID: PMC5986426 DOI: 10.3390/nu10050546] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
Vitamin D deficiency is very common and prescriptions of both assay and supplementation are increasing more and more. Health expenditure is exponentially increasing, thus it is timely and appropriate to establish rules. The Italian Association of Clinical Endocrinologists appointed a task force to review literature about vitamin D deficiency in adults. Four topics were identified as worthy for the practicing clinicians. For each topic recommendations based on scientific evidence and clinical practice were issued according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) System. (1) What cut-off defines vitamin D deficiency: even though 20 ng/mL (50 nmol/L) can be considered appropriate in the general population, we recommend to maintain levels above 30 ng/mL (75 nmol/L) in categories at risk. (2) Whom, when, and how to perform screening for vitamin D deficiency: categories at risk (patients with bone, liver, kidney diseases, obesity, malabsorption, during pregnancy and lactation, some elderly) but not healthy people should be screened by the 25-hydroxy-vitamin D assay. (3) Whom and how to treat vitamin D deficiency: beyond healthy lifestyle (mostly sun exposure), we recommend oral vitamin D (vitamin D2 or vitamin D3) supplementation in patients treated with bone active drugs and in those with demonstrated deficiency. Dosages, molecules and modalities of administration can be profitably individually tailored. (4) How to monitor the efficacy of treatment with vitamin D: no routine monitoring is suggested during vitamin D treatment due to its large therapeutic index. In particular conditions, 25-hydroxy-vitamin D can be assayed after at least a 6-month treatment. We are confident that this document will help practicing clinicians in their daily clinical practice.
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Affiliation(s)
- Roberto Cesareo
- Department of Internal Medicine, "S. M. Goretti" Hospital, 04100 Latina, Italy.
| | - Roberto Attanasio
- Endocrinology Service, Galeazzi Institute IRCCS, 20161 Milan, Italy.
| | - Marco Caputo
- Ospedale Classificato Villa Salus, 30174 Venezia Mestre, Italy.
| | - Roberto Castello
- General Medicine and Endocrinology, University Hospital, 37126 Verona, Italy.
| | - Iacopo Chiodini
- Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20149 Milan, Italy.
| | - Alberto Falchetti
- Centro Hercolani and Villa Alba (GVM), 40123 Bologna and EndOsMet, Villa Donatello Private Hospital, 50132 Florence, Italy.
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolic Diseases, Regina Apostolorum Hospital, Albano Laziale, 00041 Rome, Italy.
| | - Enrico Papini
- Department of Endocrinology and Metabolic Diseases, Regina Apostolorum Hospital, Albano Laziale, 00041 Rome, Italy.
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, 00184 Rome, Italy.
| | - Alfredo Scillitani
- Endocrinology Unit, Department of Medical Science, Ospedale Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo (FG), Italy.
| | - Vincenzo Toscano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Roma, Italy.
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Endocrinology and Metabolic Diseases, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Fabio Vescini
- Department of Endocrinology and Diabetes, Santa Maria della Misericordia Hospital, 33010 Udine, Italy.
| | - Michele Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, 42123 Reggio Emilia, Italy.
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Cesareo R, Naciu AM, Iozzino M, Pasqualini V, Simeoni C, Casini A, Campagna G, Manfrini S, Tabacco G, Palermo A. Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int J Hyperthermia 2018; 34:617-623. [PMID: 29357717 DOI: 10.1080/02656736.2018.1430868] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT No defined pre-treatment factors are able to predict the response to radiofrequency ablation (RFA) of an autonomously functioning thyroid nodule (AFTN). OBJECTIVE Primary endpoint was to evaluate the success rate of RFA to restore euthyroidism in a cohort of adult patients with small solitary AFTN compared with medium-sized nodules. Secondary endpoints included nodule volume reduction and rate of conversion from hot nodules to cold using scintiscan. METHODS This was a 24-month prospective monocentric open parallel-group trial. Twenty-nine patients with AFTN were divided into two groups based on thyroid volume: 15 patients with small nodules (<12 mL) in group A and 14 patients with medium nodules (>12 mL) in group B. All patients underwent a single session of RFA and were clinically, biochemically, and morphologically evaluated at baseline and at 1, 6, 12 and 24 months after treatment. RESULTS After RFA, there was greater nodule volume reduction in group A compared with group B (p < 0.001 for each follow-up point). In group A, there was a greater increase in TSH levels than in group B at 6 (p = 0.01), 12 (p = 0.005), and 24 months (p < 0.001). At 24 months, the rate of responders was greater in group A than in group B (86 vs. 45%; p < 0.001). In group A, 86% of nodules converted from hot to cold compared with 18% in group B (p < 0.001). CONCLUSIONS A single session of RFA was effective in restoring euthyroidism in patients with small AFTNs. Nodule volume seems to be a significant predictive factor of the efficacy of RFA in treating AFTN.
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Affiliation(s)
- R Cesareo
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - A M Naciu
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - M Iozzino
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - V Pasqualini
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - C Simeoni
- d Workers Compensation Authority (INAIL) - Research Area , Roma , Italy
| | - A Casini
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - G Campagna
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - S Manfrini
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - G Tabacco
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - A Palermo
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
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Palermo A, Fosca M, Tabacco G, Marini F, Graziani V, Santarsia MC, Longo F, Lauria A, Cesareo R, Giovannoni I, Taffon C, Rocchia M, Manfrini S, Crucitti P, Pozzilli P, Crescenzi A, Rau JV. Raman Spectroscopy Applied to Parathyroid Tissues: A New Diagnostic Tool to Discriminate Normal Tissue from Adenoma. Anal Chem 2017; 90:847-854. [PMID: 29227640 DOI: 10.1021/acs.analchem.7b03617] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary hyperparathyroidism is an endocrine disorder characterized by autonomous production of parathyroid hormone. Patients with the symptomatic disease should be referred for parathyroidectomy. However, the distinction between the pathological condition and the benign one is very challenging in the surgical setting; therefore, accurate recognition is important to ensure success during minimally invasive surgery. At present, all intraoperative techniques significantly increase surgical time and, consequently, cost. In this proof-of-concept study, Raman microscopy was used to differentiate between healthy parathyroid tissue and parathyroid adenoma from 18 patients. The data showed different spectroscopic features for the two main tissue types of healthy and adenoma. Moreover, the parathyroid adenoma subtypes (chief cells and oxyphil cells) were characterized by their own Raman spectra. The partial least-squares discriminant analysis (PLS-DA) model built to discriminate healthy from adenomatous parathyroid tissue was able to correctly classify all samples in the calibration and validation data sets, providing 100% prediction accuracy. The PLS-DA model built to discriminate chief cell adenoma from oxyphil cell adenoma allowed us to correctly classify >99% of the spectra during calibration and cross-validation and to correctly predict 100% of oxyphil and 99.8% of chief cells in the external validation data set. The results clearly demonstrate the great potential of Raman spectroscopy. The final goal would be development of a Raman portable fiber probe device for intraoperative optical biopsy, both to improve the surgical success rate and reduce surgical cost.
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Affiliation(s)
- Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Marco Fosca
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR) , via del Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Federico Marini
- Dipartimento di Chimica, Università"La Sapienza" , Piazzale Aldo Moro 5, 00185 Roma, Italy
| | - Valerio Graziani
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR) , via del Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Maria Carla Santarsia
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Filippo Longo
- Unit of Neck and Chest Surgery, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Angelo Lauria
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Roberto Cesareo
- Malattie della Tiroide ed Osteometaboliche, Hospital Santa Maria Goretti , Via Canova, 04100 Latina, Italy
| | - Isabella Giovannoni
- Unit of Pathology, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Chiara Taffon
- Unit of Pathology, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | | | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Pierfilippo Crucitti
- Unit of Neck and Chest Surgery, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Anna Crescenzi
- Unit of Pathology, Campus Bio-Medico University , via Álvaro del Portillo 200, 00128 Roma, Italy
| | - Julietta V Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR) , via del Fosso del Cavaliere 100, 00133 Roma, Italy
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Cesareo R, Palermo A, Pasqualini V, Cianni R, Gaspa G, Manfrini S, Pacella CM. Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature. Clin Endocrinol (Oxf) 2017; 87:639-648. [PMID: 28718950 DOI: 10.1111/cen.13422] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/13/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound-guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.
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Affiliation(s)
- Roberto Cesareo
- Thyroid Disease Center, "S. M. Goretti" Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | | | - Roberto Cianni
- Department of Radiology, "S. M.Goretti" Hospital, Latina, Italy
| | - Gianluigi Gaspa
- Department of Food Science and Nutrition, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Abstract
In humans, irisin is produced mainly by skeletal muscle in response to physical activity. It has been demonstrated that irisin plays a pivotal role in inducing fat browning and regulating energy expenditure. New findings from various studies conducted in both animals and humans suggest that irisin can affect bone and glucose metabolism. In particular, irisin is able to increase bone cortical mass by stimulating the osteoblast pathways, and irisin levels are inversely correlated with the incidence of fragility fractures among postmenopausal women affected by osteoporosis. Most available evidence shows that irisin significantly influences glucose and energy homeostasis. Indeed, higher irisin concentrations are inversely correlated with type 2 diabetes. Unfortunately, contradictory findings exist concerning the role of irisin in humans, and most of the human studies that have analyzed interactions between bone health, glucose metabolism, and irisin have several limitations; therefore, their results must be interpreted with caution. The purpose of this narrative review is mainly to describe the effects of irisin on glucose and bone metabolism.
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Affiliation(s)
- Silvia I Briganti
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Gianluigi Gaspa
- Department of Food Science and Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Anda M Naciu
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Roberto Cesareo
- Thyroid and Osteometabolic Disease Center, S. Maria Goretti Hospital, Latina, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy -
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50
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Pacella CM, Mauri G, Cesareo R, Paqualini V, Cianni R, De Feo P, Gambelunghe G, Raggiunti B, Tina D, Deandrea M, Limone PP, Mormile A, Giusti M, Oddo S, Achille G, Di Stasio E, Misischi I, Papini E. A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia 2017; 33:911-919. [PMID: 28605944 DOI: 10.1080/02656736.2017.1332395] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. MATERIALS AND METHODS Institutional review board approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. RESULTS No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was -67 ± 19% vs. -57 ± 21% (p < 0.001) - 70 ± 19% vs. -62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (-69 ± 19 vs. -50 ± 21, p = 0.001) and (-73 ± 18 vs. -54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.
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Affiliation(s)
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Roberto Cesareo
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | | | - Roberto Cianni
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | - Pierpaolo De Feo
- d Department of Internal Medicine , University of Perugia , Perugia , Italy
| | | | | | - Doris Tina
- e Endocrinology Unit, Atri Hospital , Atri , Italy
| | - Maurilio Deandrea
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Pier Paolo Limone
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Alberto Mormile
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Massimo Giusti
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Silvia Oddo
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Gaetano Achille
- h Cervico-Facial Ultrasound Diagnostic and Interventional Unit , Institute of Oncology of Bari , Bari , Italy
| | - Enrico Di Stasio
- i Institute of Biochemistry and Clinical Biochemistry , Rome Catholic University "Sacro Cuore" , Rome , Italy
| | - Irene Misischi
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
| | - Enrico Papini
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
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